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Clement Kids Music Spring 2019 Registration

Clement Kids

Clement Kids Music:
Spring 2019 Registration

January 14 - May 10

Clement Arts: Westminster Campus
2303 Double Churches Rd
Columbus, GA 31909

Your participation helps Clement Arts support foster and adoptive families in our community. Thank you!


Parent/Guardian Information

First Name
Last Name
Country
Address Line 1
City
State
Postal Code

Student Information

Please supply information for each student you'd like to register. You can register up to three students for music classes on this form. Please fill out an additional registration form if you are registering more than three students.

First Name
Last Name
/
/
Child is registering for the following classes (check all that apply):
Child in Foster Care?
Is your family active duty military? (10% discount)
Is your child taking more than one class with Clement Kids or do you have more than one child signed up for Clement Kids classes?
Additional class discount applies to additional child(ren) or if your child is taking more than one Clement Kids class.

Does your child have prior music experience? Describe briefly. 

Does your child have any known allergies or dietary restrictions?

Does your child have any known learning or behavioral diagnosis? This information is kept confidential and only used to help us better serve and instruct your child.

Student Information #2

First Name
Last Name
/
/
Child is registering for the following classes (check all that apply):
Child in Foster Care?
Is your family active duty military? (10% discount)
Is your child taking more than one class with Clement Kids or do you have more than one child signed up for Clement Kids classes?
Additional class discount applies to additional child(ren) or if your child is taking more than one Clement Kids class.

Does your child have prior music experience? Describe briefly. 

Does your child have any known allergies or dietary restrictions?

Does your child have any known learning or behavioral diagnosis? This information is kept confidential and only used to help us better serve and instruct your child.

Student Information #3

First Name
Last Name
/
/
Child is registering for the following classes (check all that apply):
Child in Foster Care?
Is your family active duty military? (10% discount)
Is your child taking more than one class with Clement Kids or do you have more than one child signed up for Clement Kids classes?
Additional class discount applies to additional child(ren) or if your child is taking more than one Clement Kids class.

Does your child have prior music experience? Describe briefly. 

Does your child have any known allergies or dietary restrictions?

Does your child have any known learning or behavioral diagnosis? This information is kept confidential and only used to help us better serve and instruct your child.


Terms & Conditions

I/we have chosen to have my/our child participate in music instruction given by Clement Kids Music. I acknowledge that I understand the nature of the activities my child will be participating in and the possibility that despite precautions, accidents and/or physical injury may occur.

I/we agree to release and hold harmless Clement Kids Music and Clement Arts, including its teachers, and staff members from any cause of action, claims, or demands now and in the future. I/we will not hold any of the above liable for any personal injury or any personal property damage or loss, which may occur on the premises before, during, or after classes or which may occur at any Clement Kids Music sponsored event outside the studio.

Furthermore, I/we agree to take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by Clement Kids Music.

I authorize and agree that Clement Kids Music may take and use photographs, videos, or likenesses of myself or my child as needed for its record keeping, advertising, social media and/or public relations projects and that I have no rights to the same and will not be compensated for the same.
 

Waiver Consent

Connections

How did you hear about Clement Kids Classes? Check all that apply.
Would you like to stay informed of Clement Arts news and events through our monthly email newsletter?

Billing Information

(An invoice will be sent to you soon. Please allow time for the invoice to be sent.)

Billing Option

Payment Info

Registration fees must be paid for each student.

Credit Card Information
Visa MasterCard American Express Discover

Visa®, Mastercard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Your total payment will be
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